Screening for Anxiety in the Birth Center Setting: A Quality Improvement Project

Postpartum anxiety (PPA) is a common, yet frequently overlooked, health concern for millions of women. Affecting nearly one-third of postpartum women, PPA is often, though not always, accompanied by postpartum depression. Depression receives the greatest emphasis during the perinatal period with little attention given to the prevalence and impact of PPA which can be debilitating for women. Without diagnosis or treatment, PPA can negatively affect a new mother, her baby and family structure. It has the potential to delay infant development, decrease success in breastfeeding, and increase the likelihood of maternal major depression. Only recently has a major professional nursing organization issued a position statement outlining the need for every woman to be screened for anxiety disorders in the postpartum period (AWHONN, 2015).

Additionally, the American College of Obstetricians and Gynecologists (ACOG) recommends that clinicians screen women at least once during the perinatal period for depression and anxiety symptoms using a standardized, validated tool. It is important to also note that screening by itself is insufficient to improve clinical outcomes and must be coupled with appropriate follow-up and treatment. As such, midwives should be prepared to initiate medical therapy, refer patients to appropriate behavioral health resources when indicated, or both.

The purpose of this presentation is to describe a capstone project that is in the process of implementing a screening protocol for postpartum anxiety at several birth centers throughout the U.S.A. The project details a process for educating midwives on how to screen for PPA utilizing a subscale of the Edinburgh Postnatal Depression Scale, documentation strategies, and implementation of effective treatment approaches. An approach for counseling women with high anxiety scores is presented, adapting a tool developed by the American College of Nurse Midwives – the N*U*R*S*E* Approach for Postpartum Depression. The approach emphasizes nutrition, empathy, rest and relaxation, spirituality, and exercise.